The largest hospital in rebel-held Aleppo has been hit by at least two barrel bombs amid a major offensive against the city by Russian warplanes and Syrian government forces.
The onslaught was described as causing a "bloodbath" by leading medical charity, Medicins Sans Frontiers.
Air strikes across the city overnight have killed 30 civilians,
. Another 18 were killed in air strikes in the countryside near Damascus. The death toll is expected to rise.
It was not immediately clear who was responsible for the attacks on the M10 hospital, but medical facilities have been plagued by bombing by forces loyal to the Syrian government in recent weeks.
The fierce fighting has intensified after diplomatic efforts stalled.
"There were direct hits to the hospital," Adham Sahloul of the Syrian American Medical Society told
. "There were two barrel bombs, reportedly two cluster bombs and at least one rocket of some sort that hit the hospital directly.
"It created immense damage to the facility, destroyed all the windows. It rattled all the staff and the patients there.
"As of now there's no idea as to when it can be brought back into operation. The facility is extremely damaged."
Mr Sahloul said a group of patients and doctors "were inside the hospital for basic triage, bandaging, and cleaning services for emergency cases" when the bombing started and remained trapped there.
Hospital administrator and radiologist Mohammad Abu Rajab made an emergency call for help on Saturday morning from inside the M10 hospital.
"The hospital is being destroyed! SOS, everyone!" he said in an audio message given to journalists.
Both the M10 and M2 hospitals, which are code named to protect their locations, were also attacked on Wednesday.
The Syrian Observatory for Human Rights said air strikes also hit a smaller field hospital in the Sakhur neighbourhood on Saturday.
"One person was killed and the field hospital is out of service," Observatory head Rami Abdel Rahman told
AFP.
He could not confirm whether the casualty was a patient or a member of medical staff.
Rights groups have said the hospital attacks are part of a deliberate strategy to target civilian infrastructure and therefore constitute war crimes.
The recent surge in attacks in Aleppo by forces loyal to Mr Assad have been among the most deadly in the country's five-year civil war.
At least 220 people have died and many residential buildings have been razed to the ground by the attacks.
A video posted on social media on Friday showed a traumatized toddler holding onto a nurse following an air strike in Aleppo.
The beseiged old quarter of Aleppo was bombed heavily by Russian war planes as part of a major offensive on Saturday.
Air strikes concentrated on supply lines to rebel-held areas: the Castello Road and Malah district,
reported.
Fighting raged in the Suleiman al-Halabi neighbourhood, the frontline to the north of Aleppo’s old city.
On Wednesday the US Secretary of State, John Kerry, said Washington would no longer negotiate with Moscow – key allies of the Syrian regime – if it did not stop the bombardment.
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